Provider Demographics
NPI:1720381841
Name:SOULAMON, JOSEPH J (LMT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:J
Last Name:SOULAMON
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6526 DOGWOOD PARK LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-6757
Mailing Address - Country:US
Mailing Address - Phone:713-826-1174
Mailing Address - Fax:
Practice Address - Street 1:15015 WESTHEIMER PKWY
Practice Address - Street 2:SUITE K
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-1676
Practice Address - Country:US
Practice Address - Phone:713-826-1174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-11
Last Update Date:2010-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT106565174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist